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National Center for Education in Maternal and Child Health
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October 1, 2004

1. Tool Designed to Help Schools Establish Best Practices in Nutrition and
Physical Activity
2. Analysis Examines Participation in High School Physical Education
3. Article Analyzes Trends in Social Welfare Spending on Children and the
Elderly
4. Authors Assess Child Care Center Policies and Practices for the
Management of Ill Children

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1. TOOL DESIGNED TO HELP SCHOOLS ESTABLISH BEST PRACTICES IN NUTRITION AND
PHYSICAL ACTIVITY

Criteria for Evaluating School-Based Approaches to Increasing Good
Nutrition and Physical Activity is a comprehensive tool for evaluating
school-based approaches to increasing children's physical activity and
improving nutrition. The criteria were developed by Action for Healthy
Kids (AFHK) in response to the Surgeon General's Call to Action to Prevent
and Decrease Overweight and Obesity. AFHK convened a panel of 31 experts
from 27 national organizations and government agencies to develop, test,
and apply the criteria to approaches in AFHK's "What's Working" database.
The report presents a description of the methodology for developing the
evaluation criteria, lists the actual criteria, and suggests incentives
for motivating action among stakeholders. The report is intended for use
by policymakers, educators, researchers, and others in measuring the
potential effectiveness and adoptability of a broad range of policies,
programs, interventions, and practices. The executive summary is available
at http://www.actionforhealthykids.org/docs/specialreports/exec_small.pdf,
and the full report is available at
http://www.actionforhealthykids.org/docs/specialreports/report_small.pdf.

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2. ANALYSIS EXAMINES PARTICIPATION IN HIGH SCHOOL PHYSICAL EDUCATION

"Progress has not been made toward meeting the national health objectives
for 2010 related to PE [physical education]," state the editors of a
report published in the September 17, 2004, issue of Morbidity and
Mortality Weekly Report. Two of the Healthy People 2010 objectives are (1)
to increase to greater than 50% the proportion of adolescents who
participate in daily school PE and (2) to increase to greater than 50% the
proportion of adolescents who spend at least half of school PE class time
being physically active. The report examines changes in PE class
participation among high school students in the United States from 1991
through 2003.

Data for the analysis were drawn from the national Youth Risk Behavior
Survey and included population samples representative of students in
grades 9 through 12 in the 50 states and the District of Columbia.
Temporal changes were assessed for three behaviors: (1) being enrolled in
a PE class, (2) attending PE class daily, and (3) being physically active
during PE class.

The authors found that

* Overall, the prevalence of attending PE class daily declined
significantly from 1991 to 1995 and did not change significantly from 1995
to 2003.

* The proportion of students exercising or playing sports for more than 20
minutes during PE class 3 to 5 days per week did not change significantly
during the study period.

The authors conclude that "if the national health objectives are to be
achieved, coordinated efforts involving schools, communities, and
policymakers are needed to provide daily, quality PE for all youth."

Readers: More information about physical activity in children and
adolescents is available on the Bright Futures Web site at
http://www.brightfutures.org/physicalactivity/about.htm. Information is
also available on the MCH Library's knowledge path, Physical Activity and
Children and Adolescents, at
http://www.mchlibrary.info/KnowledgePaths/kp_phys_activity.html.

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3. ARTICLE ANALYZES TRENDS IN SOCIAL WELFARE SPENDING ON CHILDREN AND THE
ELDERLY

"Changes in public policy enacted in response to national economic trends
have had great influence on the allocation of public spending," state the
authors of an article published in the September/October 2004 issue of
Health Affairs. The article describes trends in social welfare spending
for children and the elderly between 1980 and 2000 and discusses the
relationship between national economic trends and social welfare spending
patterns.

The authors examined the major components of public social welfare
spending that directly benefit children (ages 18 and younger) and the
elderly (over age 65). For children, the authors examined primary and
secondary education (K-12) programs; Aid to Families with Dependent
Children and Emergency Assistance/Temporary Assistance for Needy Families;
other child welfare, nutritional support, and maternal and child health
programs; medical spending under Medicaid and the State Children's Health
Insurance Program, and those portions of social security payments and
supplemental security insurance that benefit children. For the elderly,
the authors evaluated medical spending under Medicare and Medicaid, Older
Americans Act expenditures, veterans' and railroad workers' pensions, and
those portions of social security payments and food stamps that benefit
the elderly.

Expenditures were adjusted to 2000 U.S. dollars. National economic trends
were classified as follows: 1980-1984 recession, 1985-1989 growth,
1990-1994 recession, and 1995-2000 expansion. Percentage changes in per
capita spending were calculated for each time period. Total social welfare
spending was calculated as the sum of all relevant components for both
groups.

The authors found that

* Social welfare spending in constant dollars for both children and the
elderly increased over the 1980-2000 period; however, as a percentage of
gross domestic product, social welfare spending for both groups remained
largely unchanged.

* Per capita social welfare spending increased during the period.

* The gap in per capita social welfare spending between the two groups
increased by nearly 20% during the period.

* Spending on children's programs suffered most in 1980-82 during the
recession, when there was a 5.2% decrease in real total per capita total
social welfare spending.

The authors conclude that "whereas the elderly are afforded a basic
guarantee of support regardless of economic and political changes, social
welfare spending on children is left vulnerable to these fluctuations."
They continue, "In the current period of economic stagnation, U.S.
spending on children's social welfare programs and health care is likely
to be further compromised."

4. AUTHORS ASSESS CHILD CARE CENTER POLICIES AND PRACTICES FOR THE
MANAGEMENT OF ILL CHILDREN

"The commonly held belief that inappropriate exclusions and
recommendations to obtain antibiotics by child care staff are substantial
contributors to work days lost and unnecessary antibiotics consumed,
respectively, are not supported by these data," write the authors of an
article published in the September/October 2004 issue of Ambulatory
Pediatrics. The authors point out that despite guidelines on child care
exclusions for ill children created by the American Academy of Pediatrics
and the American Public Health Association, as well as by most states,
little is known about how exclusion policies are applied in practice and
whether they conform to recommendations. The objectives of the study
described in this article were to (1) describe child care staff knowledge
and beliefs about upper respiratory tract infections (URIs) and antibiotic
indications and (2) prospectively evaluate the appropriateness of child
care staff reported exclusions, referrals for medical care, and
recommendations that antibiotics be sought.

The authors conducted a prospective observational study in randomly
selected child care centers in Massachusetts. Thirty-eight eligible
centers agreed to participate. Child care staff completed a survey to
assess their knowledge of URIs and antibiotic indications. Then, for 6
weeks, staff completed a daily record of absences and, for each absence,
documented the reason, if known, and any advice given to the parents of
the absent child about exclusions, seeking medical care, or obtaining
antibiotics.

The authors found that

* Eighty percent of child care staff believed that antibiotics are
indicated for bronchitis and green rhinorrhea in children. In addition,
27% believed that colds and flu illnesses get better faster with
antibiotics, and 25% believed antibiotics are helpful in treating viral
infections.

* On average, 17% of children were absent from child care each day.

* Of 538 absences due to illness that child care staff discussed with
parents, there were 45 inappropriate exclusions from child care
recommended by child care staff (8.4%), 91 appropriate exclusions (16.9%),
and 402 cases (74.7%) in which no recommendation for exclusion was made
(i.e., the child's absence was not recommended by child care staff).

* Of 136 required exclusions (i.e, exclusions recommended by child care
staff), 45 (33.1%) were inappropriate. The majority (28/45) of
inappropriate exclusions were for vomiting or diarrhea. In only one case
did a staff member inappropriately recommend obtaining an antibiotic
before returning to child care.

The authors conclude that "Rather than viewing child care staff as major
contributors to inappropriate parental demand for antibiotics, we should
view these professionals as potential partners in educating families about
the treatment of common infections and the need for judicious antibiotic
use."

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